title: Use of high-pressure balloon dilatation of the ureterovesical junction instead of ureteral reimplantation to treat primary obstructive megaureter: is it justified?
abstract: OBJECTIVE
  To compare outcomes between high-pressure balloon dilatation of the ureterovesical junction (UVJ) and ureteral reimplantation with ureteral tapering to treat primary obstructive megaureter (POM).
  
  
  METHODS
  Retrospective review of clinical data from patients who underwent surgical treatment of POM from 2005 to 2010. Patients were divided into two groups: endoscopic treatment (ET) with UVJ dilatation and ureteral reimplantation (UR) with Cohen's or Leadbetter-Politano neoureterocystostomy and Hendren's tapering. Preoperative studies included ultrasound scan (US), voiding cystourethrography, and diuretic isotopic renogram. Outcome parameters were US, differential renal function (DRF), presence of postoperative vesicoureteral reflux, need for secondary reimplantation and complications.
  13 patients with a median age of 7 (4-24) months; UR: 12 patients with a median age of 14 (7-84) months, with no statistical differences in age and gender between groups. Preoperative US parameters were similar. ET: mean diameter of renal pelvis, calices and ureter was 23.5 mm, 13.46 mm and 15.77 mm respectively. UR: mean diameter of renal pelvis, calices and ureter was 22.25 mm, 11.75 mm, and 19.08 mm, respectively. Preoperative DRF was 45.62% and 39.33% for ET and UR, respectively (p > 0.05). Significant improvement of hydroureteronephrosis was observed in 11/13 patients of ET and 11/12 patients of UR (p > 0.05). Postoperative DRF was 42% and 48% for ET and UR, respectively (p > 0.05). Postoperative vesicoureteral reflux was observed in 2 patients of ET and 1 of UR (p > 0.05). Secondary ureteral reimplantation was needed in 3 patients of ET and 2 of UR (p > 0.05).
  
  
  CONCLUSIONS
  Endoscopic treatment of POM is as effective as ureteral reimplantation but further randomized clinical trials are needed to support these results.
authors.affiliation: Pediatric Urology, Pediatric Surgery Dept, Hospital Sant Joan de Déu, University of Barcelona, Spain. Electronic address: lgarcia@hsjdbcn.org.
authors.forename: L
authors.initials: L
authors.lastname: García-Aparicio
authors.forename: E
authors.initials: E
authors.lastname: Blázquez-Gómez
authors.forename: O
authors.initials: O
authors.lastname: Martin
authors.forename: P
authors.initials: P
authors.lastname: Palazón
authors.forename: A
authors.initials: A
authors.lastname: Manzanares
authors.forename: N
authors.initials: N
authors.lastname: García-Smith
authors.forename: M
authors.initials: M
authors.lastname: Bejarano
authors.forename: I
authors.initials: I
authors.lastname: de Haro
authors.forename: J M
authors.initials: JM
authors.lastname: Ribó
mesh_terms: D002648:Child; D002675:Child, Preschool; D003559:Cystostomy; D004106:Dilatation / Q000009:adverse effects / Q000379:methods; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D011312:Pressure; D012092:Replantation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
keywords: Endoscopy; Hydroureteronephrosis; Primary obstructive megaureter; Ureteral reimplantation